Provider Demographics
NPI:1306503214
Name:HAROON, SHAN AKHTAR
Entity type:Individual
Prefix:MR
First Name:SHAN
Middle Name:AKHTAR
Last Name:HAROON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12322 NW 54TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3410
Mailing Address - Country:US
Mailing Address - Phone:954-796-0364
Mailing Address - Fax:
Practice Address - Street 1:177B E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5711
Practice Address - Country:US
Practice Address - Phone:914-730-9574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009473152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist